Brain functions and the unemployed

van der Hiele K, van Gorp D, Ruimschotel R, Kamminga N, Visser L, Middelkoop H.Work Participation and Executive Abilities in Patients with Relapsing-Remitting Multiple Sclerosis.
PLoS One. 2015 ;10(6):e0129228

The majority of patients with Multiple Sclerosis (MS) are unable to retain employment within 10 years from disease onset. Executive abilities, such as planning, working memory, attention, problem solving, inhibition and mental flexibility may have a direct impact on the ability to maintain a job. This study investigated differences in subjective and objective executive abilities between relapsing-remitting MS patients with and without a paid job. We included 55 relapsing-remitting MS patients from a community-based sample (47 females; mean age: 47 years; 36% employed). Patients underwent neurological, cognitive and psychological assessments at their homes, including an extensive executive test battery. We found that unemployed patients had a longer disease duration (t(53)=2.76, p=0.008) and reported more organising and planning problems (χ2(1)=6.3, p=0.012), higher distractibility (Kendall’s tau-b= -0.24, p=0.03) and more cognitive fatigue (U=205.0, p=0.028, r=-0.30) than employed patients. Unemployed patients completed slightly less categories on the Wisconsin Card Sorting Test (U=243.5, p=0.042, r=-0.28). Possible influential factors such as age, educational level, physical functioning, depression and anxiety did not differ between groups. In conclusion, while relapsing-remitting MS patients without a paid job reported more executive problems and cognitive fatigue than patients with a paid job, little differences were found in objective executive abilities. 

This is saying what we have heard before an know already that that MS can affect cognitive functions as well as movement problems and this can impact on your ability to work

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  • Speaking personally, having had PPMS for around 15 years now, I have no perceptible affliction of cognitive function and my memory appears commensurate with others of a similar age. But I am not working as a result of lower body weakness and the enormous impact that fatigue has upon me. If I had no fatigue, I would function very well indeed.

  • I have read that over 60% of people ten years after diagnosis are still in employment.

    It amazes me that we don't have accurate data on things like this and studies say ambigious quotes like:

    "The majority of patients with Multiple Sclerosis (MS) are unable to retain employment within 10 years from disease onset."

    What do Neuros or people think?

  • I agree. Do you know what would be useful? A league table of these kind of stats across different treatments.

    Is this 60% unemployment rate based on people using first line therapies? Does Alemtuzumab early in the disease course keep you in work?

    If that is the case, patients probably you need to know that before they get talked into toileting their life on a first line therapy for the next decade, only to find themselves retired at 40 facing 50 years of financial destitution.

    Why don't you do a survey, either on the blog or in your practise, on this? Would be really interesting to see how people fare across the different therapies.

  • I thought I'd read on this same blog better figures on this. Its pretty grim.
    I wonder though if some people choose to cut hours or finish work not because the disease forces this but rather because it changes your perspective in life.

    I'm considering reducing my hours and indeed if I could afford to I'd quit work altogether. I don't have any limitations yet but knowing I could have a crushing relapse at any time of which I may not recover from kinda makes me reconsider what's important. I know if this happens I wont be thinking thank god I worked myself to the bone while I could, I'll be thinking I'd wish I'd spent my time on what makes me most happy, i.e.. spend time with family, friends and hobbies.

  • I worked full time and very long hours using all the skills stated above. My job required a good memory, attention to detail, problem solving and constant pressure. I did this job for nearly 30 years after diagnosis. I only gave up after a serious bout of cancer and my company relocating. I loved my job and it gave me independence. I discussed this recently with a friend, a fellow MS sufferer and we came to the conclusion that my brain had been doing extensive physiotherapy. Ten years on and I still have a good memory. I miss my job so much, but I know it would be impossible now.

    • Hey Anon, I guess it also depends how many lesions you have and where. How many lesions did you accumulate in the periventricular white matter, if you are willing to disclose?

    • Sorry, the only MRI scan I had was for research for the Institute of Neurology to see if it was any use for diagnosis of MS. What I will say at onset I had migraines, double vision, sensory, dizziness and nausea and spasticity. I had further admissions to hospital as my exacerbations were so severe. I'm not a doctor, all I'm saying is, that not everyone with numerous attacks has cognitive impairment that results in unemployment

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